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PubMed1998

Physician use of an ambulatory medical record system: matching form and function.

An ambulatory medical record system was implemented as a pilot project to determine the clinical and operational impacts of using interactive, computer-based systems in the outpatient setting. Of the 58 physicians who attempted to use the AMR system, 28 continue as active users. Physicians who discontinued use of the system reported a variety of reasons for their dissatisfaction. As a result of the pilot, the AMR implementation team and physicians understand better how to fit the AMR system to a physician's specific requirements, as well as enhance the operation of the physician's practice. Armed with the experience gained during the early phases of the implementation, the Cleveland Clinic Foundation now intends a cautious expansion and continued evaluation of the AMR system, with the objective of meeting organizational needs with appropriate technical functions.

Ambulatory Care Information Systems↗

PubMed1992

Health Care Linkage Project: improving access to care.

The primary objective of the Health Care Linkage Project, funded by a grant from the Chicago Community Trust, is to develop, implement, and evaluate a primary health care linkage network within the city of Chicago that creates formalized linkages between community health centers, the Chicago Department of Health clinics, and hospitals. Six linkage networks are currently operational, with an additional two sites phased in during 1991. The success of the pilot project has been demonstrated by hundreds of patients receiving primary care and ancillary services on a more timely basis, by greater coordination between the public and private sector, by cost-savings to both patients and providers through reducing inappropriate use of services, and by a variety of spin-off projects which have improved the quality and accessibility of services. A second important objective is the development of a Health Care Linkage Manual that describes the practical experience and lessons gained from the linkages, the status of comparable arrangements in other U.S. cities, replicability of the linkage models, and recommendations for policy changes which will make linkages more effective.

Chicago↗

PubMed2005

Advancing the clinical perspective: a practice development project to develop the nurse practitioner role in an acute hospital trust.

AIMS: The aims of this project were to investigate awareness and foster understanding of the concept of the nurse practitioner and to facilitate and support the development of nurse practitioner roles within an acute hospital trust. BACKGROUND: A limited understanding of and minimal support for the development of the nurse practitioner (NP) role were identified within an acute hospital trust in the south of England. This was the impetus for pursuing the project outlined in this paper. THEORETICAL PERSPECTIVE: The project used practice development theory synonymously with action research methodology comprising of four action research cycles. METHOD: Data were collected in a variety of ways within the four overlapping cycles using formal and informal methods, which were analysed concurrently during the project. Techniques included questionnaires, semi-structured interviews, meetings, discussions and the project leader's field notes' diary. OUTCOMES: A better understanding of the concept and support for NP posts were enhanced across the trust. A Nurse Practitioner Development Group (NPDG) was established, which helped to facilitate the development of NP posts. An example of such a post was established within a NP-led gynaecology pre-operative assessment clinic, which was a pilot project and constituted Action Research cycle 3. CONCLUSION: It is concluded that the development of NP roles, with the support of a NPDG, within an agreed strategy offers a robust process for NP development within an acute hospital setting. RELEVANCE TO CLINICAL PRACTICE: This project demonstrated how practice development and action research might be used together as a systematic process for developing and supporting professional roles that aim to improve the quality of patient care and the effectiveness of health care services.

Acute Disease↗

PubMedDate not supplied

Learning circles: a strategy for clinical practicum.

The author describes the use of learning circles as a strategy to increase critical-thinking skills. The author describes the origins of the learning circle strategy in experiential and cooperative learning theory, the development of a pilot project using learning circles to explore ethical issues in a clinical course, and student and instructor perceptions of the effectiveness of this strategy.

Clinical Competence↗

PubMed2006

Standardizing laboratory data by mapping to LOINC.

The authors describe a pilot project to standardize local laboratory data at five Indian Health Service (IHS) medical facilities by mapping laboratory test names to Logical Observation Identifier Names and Codes (LOINC). An automated mapping tool was developed to assign LOINC codes. At these sites, they were able to map from 63% to 76% of the local active laboratory tests to LOINC using the mapping tool. Eleven percent to 27% of the tests were mapped manually. They could not assign LOINC codes to 6% to 19% of the laboratory tests due to incomplete or incorrect information about these tests. The results achieved approximate other similar efforts. Mapping of laboratory test names to LOINC codes will allow IHS to aggregate laboratory data more easily for disease surveillance and clinical and administrative reporting efforts. This project may provide a model for standardization efforts in other health systems.

Clinical Laboratory Techniques↗

PubMedDate not supplied

Computer modelling for patient observation.

Computer modelling can be used to help release nurses from administrative functions and enable them to spend more time with patients. In this article, the authors describe pilot project in mental health nursing designed to make the planning of patient observation more efficient.

Computer Simulation↗

PubMed1993

Use of group 3-level memory telefacsimiles for enhanced interlibrary loan, part II: Network application.

The Interlibrary Loan, Document Delivery, and Union List Task Force of the Health Sciences Libraries Consortium (HSLC) accepted the charge of maximizing use of the advanced features of group 3-level memory telefacsimiles. A pilot project was initiated to address the task force's recommendation to the HSLC Board that all nonrush interlibrary loan (ILL) documents be transmitted to participants within forty-eight hours of request receipt. This paper describes the project, which tests a network application for unattended, overnight transmission of documents. In determining whether this technology could be used as the primary medium for ILL of photocopies, the following criteria were used: the percentage of ILL requests filled by telefacsimile; the speed, quality, and reliability of service; and the impact of telefacsimile on document delivery costs. The article discusses the project history, optimal use of equipment features for library applications, full-scale implementation, and operational issues that affect ILL policy.

Computer Communication Networks↗

PubMed1997

[Establishment of a laboratory information office in response to the expanding need for consultation--actual situation of the laboratory information room, Clinical Laboratory Department, Kitasato University Hospital].

Due to the advancement, segmentation and specialization of the medical care, laboratory examinations covered by the National Health Insurance (NHI) tariff have exceeded several hundred, and it is not possible for medical staff to be familiar with all of these and to utilize them appropriately. There is an urgent need for laboratory information for physicians, nurses, and other health professionals. Accordingly, our Clinical Laboratory Department, Kitasato University Hospital, established a "Laboratory Information (Consultation) Office" in July 1995 to provide consultations on clinical laboratory tests to those engaged in daily clinical practice and in medical research. The office is situated on the second floor of the Laboratory Building of the Kitasato University Hospital. One laboratory technician and one laboratory physician (clinical pathologist) are stationed there. They are available for telephone consultations from 9:00 to 17:00 on weekdays, except for holidays, and from 9:00 to 13:00 on the first, third and fifth Saturdays. In addition, since January 1997, this office also has been open to members of medical associations in various cities in our area. To cope with requests for laboratory information, including whether an examination is covered the NHI tariff, selection of appropriate screening examinations and availability of new laboratory tests, consultations by fax are accepted at any time, even after regular working hours. As a post-graduate education program, the clinical laboratory physicians study specimen handling analytical methods and interpretation of results. At medical staff meeting, personnel from the Laboratory Information Office provide clarification on the types of consultations offered, address complex questions and find resolutions for rarely encountered and difficult laboratory issues. At these meetings, a summary of new laboratory examinations also is presented. This system of an information office where full-time laboratory physicians and laboratory technicians are stationed is the first such attempt in Japan. It may be considered a pilot project to determine if such a system may be applied to other laboratory departments in the future.

Clinical Laboratory Information Systems↗

PubMed2005

Design of a standardized system for transfer of patients with ST-elevation myocardial infarction for percutaneous coronary intervention.

BACKGROUND: Direct percutaneous coronary intervention (PCI) is the preferred method of reperfusion for ST-elevation myocardial infarction (STEMI). Transfer from community hospitals to PCI centers increases availability for direct PCI, which improves outcomes compared to fibrinolysis in Europe. It has been difficult to achieve similar door-to-balloon times for transfer patients in the United States. METHODS: We designed a standardized protocol and integrated system of transfer for patients with STEMI. We report the door-to-balloon times for the pre- and postpilot patients in the index hospital and describe the details of the current Level 1 MI Program. RESULTS: In the 15 months before the pilot project, the door-to-balloon time for patients receiving ad hoc transfer for direct PCI was 192 minutes, similar to the national average. The door-to-balloon time for the patients receiving rescue PCI after failed thrombolysis was 221 minutes. The standardized protocol decreased door-to-balloon time to 98 minutes in the pilot trial (P < .01) and has now been applied successfully in 29 community hospitals. CONCLUSIONS: Rapid transfer of patients with STEMI is feasible in the United States using a standardized protocol and integrated transfer system. This requires a team approach with cooperation between cardiologists, emergency physicians, nurses, and the emergency medical system as well as various health care organizations.

Angioplasty, Balloon, Coronary↗

PubMed2004

[Antibiotic Use at German University Hospitals (Project INTERUNI-II). Results for Medical Intensive Care, Hematology-Oncology, and Other Medical Service Areas].

BACKGROUND: Excessive antibiotic use increases the risk of development and dissemination of bacterial resistance. A comparative analysis of the correlation between hospital antibiotic consumption and rates of bacterial resistance is needed for a better understanding of the complex relationship between antibiotic use and resistance. Apart from economic and market research studies, estimates of antibiotic consumption in German hospitals, however, are not available. METHODS: In a pilot project (INTERUNI-II), retrospective data from eight university hospital pharmacies covering the period 1998, 1999, and 2000 were collected to obtain estimates for the antibiotic use densities in the medical services of teaching hospitals. Antibiotic use densities were expressed as prescribed daily doses per 100 occupied bed days (PDD/100). The definition of prescribed daily doses was according to guidelines for antimicrobial therapy in adults with normal renal and hepatic function used in the participant hospitals. Means and ranges of antibiotic use densities were separately assessed for medical intensive care units (MICU), hematology-oncology services (HEMONC), and other medical services (OTHER MED). RESULTS: Mean antibiotic use density in internal medicine was 55.2 PDD/100 overall, ranging between 39.4 and 75.8 PDD/100 in the eight participant hospitals. In seven hospitals antibiotic use density increased during the years of observation. Antibiotic use was higher in MICU areas (3-year average, 122.3; range, 98-167 PDD/100) than in HEMONC (3-year average, 86.9; range, 67.8-129.4 PDD/100) and OTHER MED areas (3-year average, 42.8; range, 31.7-50.6 PDD/100). There was an increasing use of oral antibiotics resulting in a substantial proportion of oral agents among all antibacterial drugs outside MICU areas (year 2000, HEMONC, range, 36-74% of all PDD; OTHER MED, range, 43-59% of all PDD). beta-lactam antibiotics were the most frequently prescribed drugs (3-year average, 22.6 PDD/100). 56% of beta-lactam PDD belonged to the class of broad-spectrum beta-lactams (ranges, MICU, 49-82%; HEMONC, 61-89%; OTHER MED, 24-58%). Fluoroquinolones were the second most prescribed drug class (3-year average, 13 PDD/100). They were most frequently used in HEMONC (3-year average, MICU, 14.5; HEMONC 26.5; and OTHER MED 8.6 PDD/100, respectively). There was considerable variation between participant hospitals in the use of specific drug classes in given patient care areas. CONCLUSION: This retrospective study showed significant variation in overall and specific antibacterial drug class use between German teaching hospital medical services and defined patient care areas. Given the variation in the obtained estimates, targeted prospective hospital antibiotic use surveillance with fast data acquisition and analysis might offer an excellent opportunity to evaluate the impact of differences in antibiotic use and of revised therapy guidelines on the evolution of nosocomial bacterial resistance.

Administration, Oral↗

PubMed1990

A computer workstation for clinical medicine.

New computer tools for physicians, nurses, and the medical care team will become common in the 1990s. This paper describes a clinical workstation (CWS) development project that uses new technology that moves the technical support for medical decision making from the computer room to the nursing station. Collection, processing, and display of clinical information including patient identification, laboratory, and radiology results and current medications are carried out in the environment of a multi-windowed computer workstation. Easy access to automated medical literature databases from the workstation is also provided. This pilot project has successfully demonstrated a CWS operating on an acute general neurology and neurosurgical inpatient nursing unit and a critical care unit at The Johns Hopkins Hospital.

Baltimore↗

PubMed1995

Shiftwork strategies.

Nurses who learn to manage their sleep and diet while rotating shifts may feel a lot better. A pilot project aimed at improving shiftworkers' sleeping patterns and diet resulted in significant improvements in sleep, general health and psychological well-being. The five-month project, involving 10 oncology nurses in Edmonton, Alberta, included a workshop on sleep and diet, and strategies to address individual shiftwork-related problems.

Diet↗

PubMed1982

Preventive dental programs for school-age children in 8 countries: pilot survey, 1979.

This paper reports the results of a pilot project, sponsored by the FDI Working Group on Oral Health Promotion, which was designed to describe preventive dental programs for school-age children in 10 countries. A mail questionnaire was developed to obtain information about program philosophy, target population, preventive program components, promotion and educational methods, barriers to program development, program priorities and evaluation methods. In this pilot phase, a total of 27 questionnaires were returned from 8 countries (Argentina, Federal Republic of Germany, France, Japan, Singapore, Sweden, Thailand, United Kingdom). Respondents generally recognized the need to include three major program elements in order to build comprehensive programs, primary preventive measures, early detection and treatment services, and instructional activities for children and adults. Financial problems were cited most frequently as barriers to program development, followed by manpower, public acceptance, policy decisions, policy-maker attitudes, legal constraints and transportation. The domain of educational problems associated with initiating and maintaining children's preventive dental programs is broad and diverse. Educational problems, roles and methods seemed to be pervasive, cutting across all program components. Although the greatest educational emphasis appeared to be on oral hygiene, the need was also recognized to include educational components for each dental program element or service, such as fluoride rinsing. Educational needs related not only to children, but to policy-makers, dental and other health professionals and program and school personnel. The FDI Working Group has expanded the survey and collected data from a much larger number of countries during 1979-1981. Results of the larger survey will be presented at the Annual World Dental Congress of the FDI in Vienna, 1982.

Asia↗

PubMed1999

The ambulatory surgery unit as a learning experience.

Today's graduate nurses are expected to enter the work environment at increased levels of competence. Skills are expected to be ingrained, and health care administrators expect new graduates to be able to think critically. Nurse educators often are looking for new and creative ways to educate students. The ambulatory surgery setting can provide a plethora of clinical tasks and situations that teach students how to gather information, make judgments, prioritize, handle multiple demands and patients, and perform clinical skills quickly and efficiently. This article describes a pilot project in which eight nursing students learned valuable clinical and critical thinking skills in the fast-paced world of ambulatory care.

Ambulatory Surgical Procedures↗

PubMed2001

The Patient Care Notebook: quality improvement on a rehabilitation unit.

BACKGROUND: Shortened lengths of stay in acute and rehabilitation hospitals, continuing financial pressures on all postacute care services, and increasing out-of-pocket health care costs for patients and families challenge rehabilitation hospitals' patient education and discharge planning processes. Spaulding Rehabilitation Hospital (Boston) introduced a patient care notebook in a 15-bed satellite unit and pilot tested its contribution to the patient education and discharge planning process. DEVELOPING THE NOTEBOOK: The three-ring binder notebook included sections on medical appointments and phone numbers, understanding illness and medical care, coping with illness, physical activities, recommendations for the home, and community resources, with both standard and patient-specific information. RESULTS: Most of the patients and caregivers who received the notebooks found them to be helpful, and most staff indicated that the notebook improved the teaching process. Telephone calls to the unit after home discharges decreased form 28 calls for 11 discharges to 6 calls for 21 discharges after the notebook began to be used regularly. DISCUSSION: Staff felt that the process of using the notebook helped focus attention on teaching during the entire course of a patient's hospitalization rather than just a day or two before discharge. The patient care notebook process is being introduced to the entire hospital and to all patients, regardless of discharge location and the patient's literacy or proficiency with English. CONCLUSION: In using the notebook, the QI team, and the entire unit staff, learned about the complexities of QI, patient education, and discharge planning. The notebook process was implemented throughout the hospital a little more than a year after the completion of the pilot project.

Aged↗

PubMed1993

{A pro-active approach to community intervention in the rural setting}.

This paper reports an evaluation study of a pilot project held in a "CLSC" (Local Community Health Centre) located in a rural community. The intervention design is based on multidisciplinary teams created to meet specific local community needs. Mental health intervention is part of a community-based approach open to all kinds of requests for support. Practitioners in the field give support not only to the individual with a mental health problem, but also to existing self-help networks in the community. The intervention is also designed to change the relationship between a professional, seen as the one who provides services, and a client, defined as a consumer. The term "client" gains a wider meaning, and collaborative work with informal self-help networks induces a closer relationship between the community and the practitioner. The practitioner is more open to local community values and adjusts his or her practice to match variable contexts. The evaluation study has expanded knowledge of this type of intervention design, on its impact upon service demand, intervention modalities, and service management and organization. This project was coupled with a similar project in an urban environment and was financed by the Health and Social Services Ministry in Québec.

Community Mental Health Services↗

PubMed2003

Internet health-care delivery: providing nurse-led care online.

NHS Direct has proved a great success, providing advice over the phone to the public about a range of health issues. NHS Direct Online does not, however, offer a live symptom-based clinical enquiry service, yet public demand indicates this would be a welcome addition. A pilot project is now in development to meet this demand. This paper looks at the feasibility of such a service.

Delivery of Health Care↗

PubMed1989

[Obstetrics in Somalia. Maternal and infant mortality in the metropolitan area of Mogadishu. The current situation and future prospects].

Maternal and infant mortality in Somalia are very high: the obstetric situation of the country in relation to socioeconomic conditions is presented. The factors responsible for this tragic situation are outlined critically and, finally, the essential points of a pilot project aimed at lowering maternal mortality for obstetric causes from current levels (1,100/100,000 live births) which cannot be accepted even in a developing country, are summarised.

Female↗